mandatory. It is of paramount importance to delay the age at which orthopaedic surgical intervention becomes necessary as surgery early in life carries a greater risk of deformity recurrence especially in cases of ankle equines. Additionally, unjustified lengthening of the tendon Achilles is fraught with risk of over lengthening and subsequent gait deterioration namely crouch gait. In general, orthopaedic surgery for children with CP consists of tendon releases, lengthening, transposition and corrective osteotomies. For example, fixed/static ankle equinus is usually managed by gastrocnemius-soleus aponeurotic lengthening or tendon Achilles lengthening. Hip subluxation/dislocation is usually managed by adductor musculature release with or without a psoas tendon release together with femoral and pelvic osteotomies. This aims at hip joint containment and preservation. In the event that hip joint dislocation becomes longstanding and painful in elder children or adolescence, hip salvage surgery may be an option to reduce pain help nursing and improve sitting balance. A variety of surgical procedures are included under hip salvage namely valgization osteotomy and femoral head resection. Total hip arthroplasty is recommended for those with a mature skeleton, who are also likely less severely impaired. Because CP is widely heterogeneous in its presentation, surgery should be considered on a case-by-case basis. Orthopaedic surgery usually involves one or a combination of: Orthopaedic surgery as mentioned above involves releasing tight muscles and fixed joint contractures, and corrective osteotomies conducted basically to restore sagittal and rotational malalignment of bones. Orthopedic surgery is most often performed on the hips, knees, hamstrings, and ankles. For example, hip adductor release, musculotendinous lengthening for equinus gait, femoral derotational osteotomy, and knee extension osteotomy are commonly practiced. Less commonly, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers. Other surgeries The insertion of a baclofen pump usually during the stages while a person is a young adult. This is usually placed in the left abdomen. It is a pump that is connected to the spinal cord, whereby it releases doses of baclofen to alleviate continuous muscle flexion. Baclofen is a muscle relaxant and is often given by mouth to people to help counter the effects of spasticity, although this has the side effect of sedating the individual. The pump can be adjusted if muscle tone is worse at certain times of the day or night. The baclofen pump is most appropriate for individuals with chronic, severe stiffness or uncontrolled muscle